"How many times have you seen someone getting beat up in your neighborhood? Seen someone attacked with a knife or gun? Had a gun pointed at you or someone else? Had someone threaten to hurt you?"
Sixth-graders at Foshay Learning Center in South Central Los Angeles answered these questions last year as part of a group screening designed to measure their exposure to violence. Initially, staff members were shocked at the high level of violence students had experienced in their neighborhood - as well as the high rates of Post-Traumatic Stress Disorder (PTSD) and depression.
"Some told us they heard shootings outside their home at night or experienced domestic violence in the home. One was at the scene of an armed robbery. Some had been directly threatened and even witnessed a loss of life," recalls Suzanne Garrett, a psychiatric social worker at the school.
After the screening, 126 sixth-graders who had witnessed or experienced violence were selected to be part of a study. Divided into two groups, some received immediate treatment in a program called Cognitive Behavioral Intervention for Trauma in Schools (CBITS) while the rest waited three months to get therapy.
CBITS, a collaboration between the RAND Corp., the Los Angeles Unified School District (LAUSD) and the University of California, Los Angeles, includes 10 weekly therapy sessions led by trained school social workers and therapists for six to eight students at a time. The program is funded by a three-year grant from the U.S. Department of Health and Human Services, which expires at the end of this school year. Organizers hope it will be renewed.
During the therapy sessions, students were encouraged to talk about their experiences repeatedly. Even though it was painful, it was a way for students to come to grips with their traumatic experiences.
"The theory is that traumatic events are stored in one's psyche in a way that can cause difficulties if they are not processed," says Garrett, a member of United Teachers Los Angeles (UTLA). Talking through the experience "allows the brain to reprocess the event in a safe, controlled environment. It's a form of desensitization."
Students learn relaxation techniques to control stress and anxiety, and strategies for controlling "bad thoughts." They explore problem-solving techniques in group discussions and learn how to cope through drawing pictures and writing in journals.
"If they've witnessed a shooting on the street," says Garrett, "we might ask them to focus on the experience of seeing someone with a gun. We take one small part of their experience and do drawings and write narratives. It's not uncommon to have some students get anxious or upset. We pull those students aside and use relaxation techniques to get them back to a state of relative calmness. We monitor them very carefully.
"Relaxation, deep breathing and positive imagery are techniques they will be able to use in all situations in life that are stressful."
The program helps teachers recognize the symptoms of trauma and provides information on how to teach traumatized children.
It's not uncommon to mistake Post-Traumatic Stress Disorder for defiance or Attention Deficit Disorder. Common reactions to trauma include anger, inability to concentrate, being constantly on guard, and developing minor physical ailments.
"We offered inservice to teachers at Foshay to educate them about the whole process," says Garrett. "Although some individual teachers had some resistance to children missing class, they realized that ultimately it would be very beneficial for students."
Parental involvement is strongly encouraged in the program. Many parents told Garrett that they were unaware that their child had experienced violence.
Students may choose not to confide in parents or other adults because they don't want to admit they are afraid; they want to keep them from worrying; they fear retaliation; they believe that adults will do nothing, because turning a blind eye is a survival mechanism in violent neighborhoods; or they fear that they will suffer restrictions.
The program encourages students to talk with their parents about their problems so they can work through the trauma together.
"It is painful for parents to acknowledge that their children have been exposed to these things, and know they can't do anything about it," says Garrett. "Most of them can't just pick up and move. The reality may be that it's the only housing they can afford."
The program has been successful in LAUSD. During the 2001-02 school year when it was implemented, 86 percent of the students in the study group had fewer symptoms of violence-related stress, 67 percent had fewer symptoms of depression and more than 75 percent of the parents reported that their children were functioning better.
Ingrid Moore, a sixth-grade math and science teacher at Foshay, has noticed improvement in four of her students who participated in CBITS. "One, in particular, was very restless and could have easily been influenced into joining gang activity. He had anger issues. He was always being referred to the dean's office. He had trouble focusing and trouble relating to his peers and other adults in the classroom. But academically, he was capable of doing the work." After he went through the program, referrals to the dean's office decreased, and his grades and cooperation increased.
"I think we need to have more programs like this," says Moore, a member of UTLA. "There is violence in this community. We have gang activity, drugs, shootings and police conflicts. On the good side, there are many wonderful, positive people living here. But the violence that students experience is a growing concern that we should focus on."
Marleen Wong, director of crisis counseling and intervention for LAUSD, believes that the CBITS program should be widely implemented, especially in high-poverty areas. In the past, schools have not been able to identify kids who are suffering from depression and trauma. But that's changing. "Our screenings take only 45 minutes."
"Schools screen children for vision and hearing problems because children can't learn if they can't see and hear," adds Wong, who works at the UCLA National Center for Child Traumatic Stress. "But if kids are suffering from trauma and depression, they can't learn either. Maybe it's time to screen children for trauma and depression - especially in poor communities - and level the playing field. We need to help these kids early on. That way they have a real chance to take advantage of the educational opportunities that are available to them."
